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3D Ankle Fracture

The Association Between Preoperative 3D Rendering Prior to an Elective Total Knee, Shoulder or Hip Arthroplasty and Postoperative Outcomes: Real World Evidence from the OHDSI Network.

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3D Ankle Fracture

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  1. The Association Between Preoperative 3D Rendering Prior to an Elective Total Knee, Shoulder or Hip Arthroplasty and Postoperative Outcomes: Real World Evidence from the OHDSI Network Matthew Spotnitz, M.D., M.P.H., Edward Burn, D. Phil., Thomas W. Hamilton, M.D., D. Phil., Jeffrey A. Geller, M.D., Karthik Natarajan Ph.D.

  2. 3D Ankle Fracture Rowe SP, Fritz J, Fishman EK Emerg Radiol (2018) 25:93–101

  3. Background: 3D Rendering • 3D renderings are reconstructed from cross sectional images (CT, MRI, etc..) • Widely used for visualizing complex anatomy and pathology • CPT codes 76376 and 76377 introduced in 2006 • Without or with an independent workstation (i.e. CT scan vs. 3D Lab) • Reimbursement policies for 3D renderings vary by insurance providers • We are interested in large scale, observational data about preoperative use of 3D rendering before a total knee arthroplasty (TKA), total shoulder arthroplasty (TSA) and total hip arthroplasty (THA)

  4. MIP < 1995 VR 1995 CR 2015 CR 2015 CR 2015 CR 2015 Rowe SP, Fritz J, Fishman EK Emerg Radiol (2018) 25:93–101

  5. Background: Arthritis and Arthroplasties Arthritis TKA UKA https://orthoinfo.aaos.org/en/treatment/unicompartmental-knee-replacement/ https://orthoinfo.aaos.org/en/treatment/total-knee-replacement/

  6. Public Health Impact: Revision Arthroplasties • Revision arthroplasties cost more than $3.5 Billion to the United States Healthcare System • Aseptic mechanical loosening is a leading cause of TKA, TSA, and THA revision • 3D rendering use may reduce incidences of mechanical loosening and revision arthroplasties Delanois RE, Mistry JB, Gwam CU, et. al. The Journal of Arthroplasty 32 (2017) 2663-2668 Gwam CU, Mistry JB, Mohamed NS, et. al. The Journal of Arthroplasty 32 (2017) 2088-2092. Aibinder WR, Schoch B, Schleck C. J Shoulder Elbow Surg 2017 Mar;26(3):443-449

  7. Preop 3D Rendering: Hypothetical Advantages • Create Intuitive Visualization of Anatomy and Pathology • Provide Quantitative Measurements • Improve Decisions about Surgical Access • Improve Choice of Prosthetic • Improve Communication among Patients, Healthcare Providers and Trainees

  8. Study Design • A set of retrospective, observational, cohort studies • Study Period: 01/01/2006 – Present • Comparison 1: 3D prior to TKA vs. No 3D prior to TKA • Comparison 2: 3D prior to TSA vs. No 3D prior to TSA • Comparison 3: 3D prior to THA vs. No 3D prior to THA • Outcomes Cohorts: TKA, TSA, THA Revision • Time-At-Risk: POD#1 – End of Study Period • Propensity Score, Negative Controls, Positive Controls

  9. 3D TKA Cohort • TKA is the index event, first procedure occurrence, on or after 1/1/2006, 365 days of medical records prior • At least 1 3D Rendering within 90 days prior to index event • Not a robotic or computer-assisted procedure • Age 40+ • No prior knee revision procedure • No prior knee arthroplasty procedure, observation or condition • No fracture of bone of knee joint within 90 days prior to index event

  10. Preliminary Results and Analysis Plan • Preliminary results suggest that 3D rendering cohorts consist of patients who are more complex and are use medical imaging more often than the patients in the comparator cohort • Consistent with another analysis of an NYC based central data repository, the proportions of 3D renderings done without and with an independent workstation are similar • Time to Revision • Proportion of Revisions • Cost Effectiveness • Variance by Site and Insurance Provider

  11. Discussion Outline • Changes to preoperative arthroplasty imaging workup • Insurance Coverage • Imaging Nuances • Evolution of 3D Rendering Technology • 3D Printing/Patient Specific Instrumentation • Preop planning vs. Computer-Assisted or Robotic Guidance • Limitations of Codes and Phenotypes • Uncontrolled Confounding

  12. Thanks! • Study Authors (Columbia and Oxford) • Dr. Patrick Ryan • Maura • Future OHDSI Collaborators

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